Medicare, Physicians | JD Supra Law News

CMS Proposes New Standard for Hospital Inpatient Admissions

by Leslie Demaree Goldsmith | Ober|Kaler on 5/17/2013

As part of its proposed inpatient prospective payment systems (IPPS) rule for FY 2014, CMS introduced a new standard for determining whether an inpatient admission to an acute care hospital is appropriate. Specifically, CMS...more

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

by King & Spalding on 5/17/2013

On May 8, 2013, a jury concluded that Tuomey Healthcare System, Inc. (Tuomey), a community hospital in Sumter, S.C., violated the Stark law for allegedly improper compensation arrangements in 2005 between the hospital and 19...more

Members of Senate Finance Committee Call for Repeal of Physician SGR, Seek Input from Provider Community

by King & Spalding on 5/15/2013

On May 10, 2013, Senators Max Baucus (D-MT) and Orrin Hatch (R-UT)—the Chairman and Ranking Member of the Senate Finance Committee, respectively—issued a letter to the healthcare provider community declaring that “[t]he...more

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

by Calvin Marshall | Chambliss, Bahner & Stophel, P.C. on 4/26/2013

On April 1, 2013, the U.S. Court of Appeals for the Sixth Circuit overturned an $11.1 million False Claims Act (FCA) judgment by the U.S. District Court for the Middle District of Tennessee against MedQuest Associates, Inc.,...more

Arrests Made and Investigation Underway at a Chicago Hospital

by King & Spalding on 4/23/2013

On April 16, 2013, the United States Department of Justice (DOJ) and U.S. Attorney’s Office in the Northern District of Illinois announced the arrest in Chicago of the owner and senior executive of Sacred Heart Hospital...more

Sixth Circuit Holds Physician Supervision and Enrollment Issues Are Not Conditions of Payment for Purposes of FCA Liability

by Darby C. Allen, B. Scott McBride | BakerHostetler on 4/23/2013

The Sixth Circuit Court of Appeals recently issued a decision overturning an $11.1 million False Claims Act (FCA) verdict against MedQuest Associates, Inc. (MedQuest) for submitting claims to Medicare in violation of the...more

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

by Chelsey Hadfield, Ty Howard, Jack Selden | Bradley Arant Boult Cummings LLP on 4/23/2013

This spring saw two significant victories for health care providers in the federal courts of appeals. In both cases, the courts rejected an aggressive government theory under the False Claims Act (FCA), the first related to...more

IOM Committee Releases Interim Findings on Geographic Value Index

by King & Spalding on 4/5/2013

On March 22, 2013, the Institute of Medicine Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care (IOM Committee) released an interim report analyzing a potential Medicare payment policy,...more

Health Care Reform Update -- April 2, 2013

by Joseph P. Hammang, Alexander Hecht, Kevin M. Kappel, Tom Koutsoumpas, Jeremy Rabinovitz, Robert C. Skinner | Mintz Levin - Health Law on 4/3/2013

In This Issue: Implementation of the Affordable Care Act (ACA); Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

by Donna Senft | Ober|Kaler on 3/30/2013

In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

CMS Issues Rules On Physician Payments Sunshine Act

by Michael Volkov on 3/15/2013

People like to think they have it the hardest in life. I call it the competition among victims. If you are in the healthcare industry and fall under the Physician Payments regulations, then I think you are on your way to...more

CMS Issues Proposed Rule to Reform "Unnecessary, Obsolete, or Excessively Burdensome" Medicare Participation Standards

by Sarah Baker, Dinetia Newman | Bradley Arant Boult Cummings LLP on 2/20/2013

On February 4, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to reform Medicare regulations that CMS views as unnecessary, obsolete, and/or excessively burdensome on hospitals and health care...more

Here Comes the Sun: Final Rules Implementing the Federal Sunshine Law

by Ropes & Gray LLP on 2/20/2013

On February 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule implementing the Federal Sunshine Law (42 U.S.C. 1320a-7h). (The rule was subsequently published in the Federal...more

CMS Issues Final Rule for Implementing Sunshine Act

by Wilson Sonsini Goodrich & Rosati on 2/14/2013

On February 8, 2013, 16 months after the statutory deadline, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register the final regulation implementing the physician payment transparency...more

OIG ?'s Co-Management Arrangement for Cardiac Cath Labs

by Daniel Murphy, Dinetia Newman | Bradley Arant Boult Cummings LLP on 2/8/2013

On January 7, 2013, the Department of Health and Human Services Office of Inspector General (“OIG”) posted a favorable advisory opinion concerning an existing co-management arrangement (“Arrangement”) between a large, rural,...more

The Physician Payment Sunshine Act Final Rule A Summary Of Key Provisions

by Pat A. Cerundolo, Igor Gorlach, Tad Heuer, Colin J. Zick | Foley Hoag LLP on 2/8/2013

On February 1, 2013, Centers for Medicare and Medicaid Services (CMS) published the long-awaited Physician Payment Sunshine Act (Sunshine Act) Final Rule, implementing Section 1128G of the Social Security Act. The...more

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Reports on Physician Ownership...

by Sarah Crotts | Womble Carlyle Sandridge & Rice, PLLC on 2/8/2013

Reports on Physician Ownership and Investment Interests The Sunshine Act requires applicable manufacturers, as well as applicable GPOs, to report to the Secretary, in electronic form, certain information concerning...more

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Report Submission and Review

by Sarah Crotts | Womble Carlyle Sandridge & Rice, PLLC on 2/8/2013

Report Submission and Review Pre-Submission Review is Not Required Applicable manufacturers may voluntarily provide covered recipients the opportunity to review the data prior to submission to CMS, but doing so is not...more

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Medicare › Physicians

CMS Proposes New Standard for Hospital Inpatient Admissions

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

Members of Senate Finance Committee Call for Repeal of Physician SGR, Seek Input from Provider Community

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

Arrests Made and Investigation Underway at a Chicago Hospital

Sixth Circuit Holds Physician Supervision and Enrollment Issues Are Not Conditions of Payment for Purposes of FCA Liability

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

IOM Committee Releases Interim Findings on Geographic Value Index

Health Care Reform Update -- April 2, 2013

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

CMS Issues Rules On Physician Payments Sunshine Act

CMS Issues Proposed Rule to Reform "Unnecessary, Obsolete, or Excessively Burdensome" Medicare Participation Standards

Here Comes the Sun: Final Rules Implementing the Federal Sunshine Law

CMS Issues Final Rule for Implementing Sunshine Act

OIG ?'s Co-Management Arrangement for Cardiac Cath Labs

The Physician Payment Sunshine Act Final Rule A Summary Of Key Provisions

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Reports on Physician Ownership...

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Report Submission and Review

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Covered Recipients

CMS Issues Final Rule to Implement Physician Payments Sunshine Act

CMS Issues Final Physician Payment Sunshine Rule

CMS Publishes Final Sunshine Act Rule

Major New Jersey Health System Pays $12.6 Million To Settle False Claims Act Suit Alleging Physician Kickback Scheme

CMS Alters Procedures for Physicians Practicing in CAHs to Qualify as Meaningful Users

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